Hospice News recently sat down with Kirk Allen, senior vice president of the home care segment at Humana Inc. (NYSE: HUM) to discuss the payor’s perspective on the first year of the hospice component of the demonstration of value-based assurance design (VBID).
Some hospices have reported discrepancies between the design of Medicare Advantage carve-in and its results. Humana told Hospice News the company is encouraged by the progress of the demonstration to date and that there are “many opportunities” in the evolving relationship between hospice providers and payers.
The carve-in began with a small start with 53 participating Medicare Advantage plans in 2021. The US Centers for Medicare & Medicaid Services (CMS) have indicated that participation will double next year to a total of 115 plans. MA and would expand its geographic reach to become available in 461 counties nationwide, up from 206 this year.
Humana operates most of the MA plans offering palliative care and also participates in VBID as a supplier, through its subsidiary Humana at Home. In the first year, Humana covered 145,000 eligible members in 10 plans and in five markets: Atlanta, Cleveland, Denver, Metro Louisville, Kentucky (including southern Indiana), and the Greater Montreal area. Richmond-Tidewater, Virginia.
The company’s role as both payer and provider has given Humana a unique perspective in the value-based payments space, according to Allen.
What has Humana’s experience been so far with value-based demonstration, both as a payer and as a supplier?
We have watched the creation of the hospice from the very beginning and we think it is a very well thought out plan that CMS and [the Center for Medicare & Medicaid Innovation (CMMI)] have set up for the VBID demonstration. Our experience has shown us that it delivers pretty much exactly what we thought it would deliver today in the first year.
From Humana’s point of view, we are one of the biggest suppliers, [and] due to our size and being one of the first and biggest entities in VBID, we really had a good experience. Each market is a little different in the dynamics of health care delivery. We chose not only to put a variety of markets, but also to test specific things in each market.
From a vendor engagement perspective, we’ve actually had a lot of vendors reaching out with interests in the plan, and we’ve had a lot of vendors signing up and becoming network vendors.
We’ve also had a lot of vendors who have decided they want to cooperate, but they’re going to wait a year later to participate. We have a very good interest in the program and the end of the first year is exactly where we expected it to be.
What are the most important things hospices really need to pay attention to if they are considering participating in VBID?
We are also a hospice provider, and we also had to do this plan ourselves with an understanding of the overall goals of the demonstration. Among these goals, CMMI wanted to test a Medicare Advantage organization’s ability to be truly financially responsible and accountable from the start to the end of the full continuum of care for its members. It includes palliative care, and that’s certainly one of the things they were looking at.
They are also exploring the possibility of creating a seamless continuum of care in a master’s program, especially between the coordination services of parts A and B. What struck me was the need to have care services. comprehensive palliative care outside of the palliative care provision available under the plan. When someone makes the choice of a hospice, it is clear that we have to take care of them as part of the hospice plans, but there is also a requirement that we make palliative care available upstream of the hospice. patient’s decision to elect a hospice.
Also, to understand the general objectives of the CMMI VBID demo, you really want to develop a relationship with the MA plans which have a large market share in your area. If you are interested in becoming a supplier, you want to get in early and give your opinion on how the benefits are developed. This is still a demonstration project, and it’s still in development, so it’s about being able to contribute to the scope of care that can be provided and how payment models are structured and to be a partner in AM plans.
As these plans are finalized or they become more cooked, take full advantage of the additional and additional benefits for your patients that will likely be available through a palliative care plan provided by the MA.
Can you clarify what benefits hospice providers should focus on as VBID continues to roll out?
One opportunity is to provide concurrent care and concurrent transitional care in conjunction with a Medicare Advantage plan. You can start hospice services while someone is still receiving concurrent transitional care, and this is something that under normal circumstances would have made a person ineligible for hospice care.
For example, in our model, we have advantages such as home respite in addition to hospital respite. We offer a benefit where a member can add a member or a patient can access home respite care services, and we’ve seen that play out in different ways. We have seen patients able to stay at home or give their caregiver a break in circumstances that might otherwise have turned into someone revoking palliative care benefits.
Another benefit offered by Humana as an example of the types of benefits and MA plans offered in addition to the traditional payment is a Health Care Assistance Allowance for members of the hospice. We have an additional benefit of $ 500 per year which is used to support the quality and comfort of life of our members. We can use it for home modifications, meals, transportation, caregiver support and a lot of other things as well, but it’s really to alleviate any social determinants of a patient’s health needs that can help. to make her episode of palliative care more enjoyable. .
A common concern among providers is that MA plans will pay less than the current per diem through Hospice Medicare. How do you respond to this concern? Are there factors that mitigate this financial risk?
We really approached this demo as an opportunity to learn. We are particularly interested in reducing the barriers patients face in electing a hospice and making it easier for them to stay on the hospice allowance when medical issues arise, and then helping with social determinants that can really influence negatively. their experience during the hospice. In addition to the standard hospice payment, our approach has been to pay for services that are not covered by traditional health insurance or through these additional benefits in order to reduce barriers to providing services through the additional benefits. .
What I would say to a provider is that as you learn more about MDA plans, assess everything that is available in the payment model, basic payment and those additional benefits. and how this might influence the ability to keep patients in your department who might otherwise revoke or interrupt services. You want to let them benefit from the provision of palliative care as part of value-based care and make sure there is no disruption in care and there are no challenges that you would have had if they had benefited from the traditional service. Looking at the model as a whole would be my advice.
Providers have expressed concern that MA plans are not using their networked hospices to provide palliative care. How would you respond to this concern?
We really liked the fact that CMMI requires below the provision of palliative care services as part of the VBID demonstration, as we strongly believe in identifying end-of-life patients and ensuring they have access to all the services they need in this really vulnerable time. We went into the demo with the intention of testing different things, and we were actually really intentional about it.
We pay hospice organizations to provide hospice care in our model. We actually have markets where the hospice agencies are the hospice providers, and we have a mix in a market where it could be a dedicated hospice provider that is not a care agency. palliative. We also have whole markets where the test is [about] how effectively a hospice palliative care agency can provide hospice and palliative care once elected.
In short, we have a mix of hospice providers and hospice agencies dedicated to providing care, and this is one of the things that we specifically tested during the demonstration is to really share the results that we have.
What do you expect to happen in the long term with respect to value-based care in the palliative care space? Where is it ultimately going?
Humana has had a very good experience in providing value-based care. What we have learned is that there is a path to value that will come over time, but it requires learning in partnership with palliative care providers.
We really believe that there are many opportunities to evolve the relationship between palliative care providers and payers and to be able to test these value-based end-of-life care models. Palliative Care really strives to better integrate the end-of-life care experience for our AD members and for palliative care patients. It will be a data driven approach to really learn what works well over time and it will take time, but I think we’ll get there. We have to learn it together.